NPIMap

Organization Active NPI

Child Development Network

  • Clinical Neuropsychologist
  • Lexington, MA
National Provider Identifier
1902952658
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
Legal business name
CHILD DEVELOPMENT NETWORK
Practice address
76 Bedford St Ste 12
Lexington, MA 02420-4640
Phone
(781) 861-6655
Fax
(781) 861-6654
NPI assigned
Jan 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Janine Korahais Stasior, PHD, MS
Title
Neuropsychologist, Business Owner
Phone
(781) 861-6655

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X Primary

Addresses

Primary practice location

76 Bedford St Ste 12
Lexington, MA 02420-4640

Mailing address

76 Bedford St Ste 12
Lexington, MA 02420-4640
Phone (781) 861-6655

Other identifiers 1

IdentifierTypeStateIssuer
W10652OtherMABLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory
Tax ID family
Child Development Network3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902952658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "76 BEDFORD ST STE 12",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024204640",
            "telephone_number": "781-861-6655",
            "fax_number": "781-861-6654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 BEDFORD ST STE 12",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024204640",
            "telephone_number": "781-861-6655",
            "fax_number": "781-861-6654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD DEVELOPMENT NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STASIOR",
        "authorized_official_first_name": "JANINE",
        "authorized_official_middle_name": "KORAHAIS",
        "authorized_official_title_or_position": "NEUROPSYCHOLOGIST, BUSINESS OWNER",
        "authorized_official_telephone_number": "781-861-6655",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, MS"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "W10652",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.